Case Management Training and Quality Auditor
TRAINING & QUALITY AUDITOR
POSITION SUMMARY
This position will participate in the conceptualization, development, and execution of training programs. Deliver engaging, informative, and motivating training activities. Collaborate with internal departments to implement quarterly "refreshers." Additionally, perform quality and risk management evaluation and analysis, regulatory and compliance responsibilities through collaboration with the Data Analyst.
ESSENTIAL FUNCTIONS
Develop course content, core competencies, evaluation tools, and materials for training activities
Manage quarterly updates of reference materials for proprietary strategies and other assigned areas
Proposes and implements recommendations for improved processes including the identification of training requirements, training gap analysis, and employee needs assessment/s
Designs, delivers and responds to development requests from other departments
Organize and facilitate the onboarding of department new hires
Facilitates, and reviews audit results from all department teams; audits consist of any entry made related to a member
Identify and analyze case impacts for Allied Care Medical Management Reporting to ensure content represents overall member engagement to further enhance client retention and assist in marketing to new business
Perform audits of department-related claims, specifically CVS Caremark, limited distribution drug arrangements, transplant, and miscellaneous claims processed by the Enhanced Case Management Advocate to ensure appropriate payment is made
Identifies department-wide trends and offers suggestions for improvement and or additional areas of focus
Collaborate with Data Analyst in data gathering, analysis, and reporting metrics as needed
Collaborate with Data Analyst to identify enhancements that will improve processes and support future business needs
Other duties as assigned
EDUCATION
Bachelors degree or equivalent work experience required.
EXPERIENCE & SKILLS
2 years of training experience required, preferably in healthcare or social service industry
Comfortable with medical terminology
Strong verbal and written communication skills
Ability to collaborate with internal and external stakeholders
Intermediate level experience with Microsoft Suite products, including Office, Word, Excel, Access and Power Point
Ability to function well in a high-paced and at times stressful environment
POSITION COMPETENCIES
Job Knowledge
Time Management
Accountability
Communication
Initiative
Customer Focus
PHYSICAL DEMANDS
This is a standard desk role - long periods of sitting and working on a computer are required.
WORK ENVIRONMENT
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
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